Involving carers in risk assessment: a study of a structured dialogue between mental health nurses and carers.

BACKGROUND: Involving carers is a key priority in mental health services. Carers report the sharing of service users' safety information by mental health nurses is problematic and seldom takes place. AIMS: The impact of an intervention on consensus between nurses and carers on perceptions of risk was investigated. METHODS: Carer-nurse risk consensus scores were measured pre- and post-introduction of a structured dialogue (paired t-test/ANOVA). Carer experience with involvement was surveyed pre-test (n = 60) and compared with the post-test intervention group (n = 32) (chi-square tests of linear-by-linear association). RESULTS: Consensus and perceptions regarding type and severity of risk did not change significantly for carers or nurses after engaging in a structured dialogue. Statistically significant differences were found with carers reporting higher levels of satisfaction with services in four out of six areas surveyed. CONCLUSIONS: Findings provide support for increasing carer contribution to discussions regarding risk. Further work to embed carer involvement in clinical practice is warranted.

Signal Transduction Peptide of Tissue Factor Phosphorylated at Ser258 and the Unphosphorylated STP in Urine Are Potential Biomarkers for Bladder Cancer.

BACKGROUND: Procoagulant activity attributed to tissue factor (TF, CD142) bound to lipid microvesicles has previously been shown to be elevated in urine of patients with various solid cancers. The phosphorylation of the C-terminal signal transduction peptide (STP) at Ser253 and Ser258 has been determined to be important for the formation of TF-microvesicles. The purpose of this work was to investigate the marker potential of the TF-STP domain in urine of patients with cancer using immunologic methods to quantitate unphosphorylated TF and TF phosphorylated at Ser253 and Ser258. MATERIALS AND METHODS: We developed monoclonal and polyclonal antibodies directed against the 3 C-terminal STP species of TF and constructed 3 enzyme-linked immunosorbent assays (ELISAs) that specifically recognize unphosphorylated TF and TF phosphorylated at either Ser253 or Ser258. As proof of principle, a preliminary pilot study with stored Biobank-sourced urinary specimens from 45 healthy individuals and 38 patients with bladder cancer were studied using these ELISAs. RESULTS: We report that all 3 species of TF were found in the urine. Two species, TF-pSer258 and unphosphorylated TF, were significantly elevated in the cohort with bladder cancer. The sensitivity of TF-pSer258 by the receiver operator characteristic technique was 86.8%, with a specificity of 97.8% at a cutoff value of 0.55 ng/mL. Using a simplified sample preparation method for the ELISAs on the same clinical specimens, the sensitivity of TF-pSer258 was 86.8%, with a specificity of 93.3% at a cutoff value of 0.53 ng/mL. The unphosphorylated TF species was significantly elevated in later stage bladder cancer with best results seen for the unfractionated preparation technique (95% confidence interval, 10.55-15.74; N = 20) but not early stage non-muscle-invasive bladder cancer (95% confidence interval, 4.71-10.73; N = 18; P < .02). CONCLUSIONS: The development of these new ELISAs allows the quantitation of the urinary biomarkers TF-pSer258 and unphosphorylated TF, which may lead to a new diagnostic approach to the early detection of bladder cancer and warrant further investigation in a prospective trial.

The relationship between perceived organisational threat and compassion for others: Implications for the NHS.

The National Health Service (NHS) is known to be a challenging place to work, with financial and performance targets placing increasing pressure on the organisation. This study aimed to investigate whether these pressures and threats might be detrimental to the quality of care and the compassion that the NHS strives to deliver. Quantitative data were collected via self-report questionnaires from healthcare professionals across 3 NHS trusts in England in order to measure Self-compassion; Compassion for Others; Perceived Organisational Threat; and Perceived Organisational Compassion. Qualitative data were also collected to explore the threats considered most pertinent to healthcare professionals at present. The key findings suggest that an increase in Perceived Organisational Threat may reduce an individual's ability to give compassion to others; however, Self-compassion and Perceived Organisational Compassion were better predictors of Compassion for Others. This highlights the need to consider compassion at a systemic level, providing interventions and training not only to cultivate self-compassion in healthcare professionals, but also to encourage compassion across the NHS more generally. In promoting self-compassion and increasing the level of compassion that employees feel they receive at work, healthcare professionals may be better able to maintain or improve their level of compassion for service users and colleagues.

Suicide-Related Internet Use Among Suicidal Young People in the UK: Characteristics of Users, Effects of Use, and Barriers to Offline Help-Seeking.

The study replicates earlier research using a UK sample to examine differences between suicidal people who go online for suicide-related reasons and suicidal people who do not, perceived effects of suicide-related Internet use, and perceived barriers to offline help-seeking. A total of 72 UK citizens (18-24 years old) who had contemplated killing themselves or deliberately harmed themselves with the intention of dying within the past 12 months participated in an anonymous online survey. Results indicate that suicidal young people who use the Internet for suicide-related purposes are a high-risk group characterized by higher levels of social anxiety. The main purposes of suicide-related Internet use were to connect with others and seek information. Both positive and negative effects were found.

Vaccination timeliness in preterm infants: An integrative review of the literature.

AIMS AND OBJECTIVES: To take a systematic approach to reviewing the scientific literature examining the timeliness of vaccination in preterm infants and to identify any factors associated with timeliness. BACKGROUND: Preterm infants are vulnerable to infection and guidance advocates they are vaccinated in accordance with their full-term peers. Vaccination is well tolerated and protective immune responses are observed, yet some early enquiries suggest that preterm infants experience unwarranted delays. The recent surge in pertussis cases and the increase in vaccinations administered make this a topic requiring further exploration. DESIGN: An integrative review of the empirical literature. METHODS: Studies were identified following a search of Medline, Academic Search Premier, Cochrane Database of Systematic Reviews and the Cumulative Index to Nursing and Allied Health Literature. The review methods used were influenced by a narrative synthesis approach. The retrieval of papers adhered to recognised reporting standards. RESULTS: Fourteen studies were identified, which indicated that infants with the lowest gestational ages and birthweights experience the greatest delays. Vaccination timeliness is influenced by hospitalisation and increased postdischarge follow-up. There was a lack of consensus to indicate that parental socio-economic status and level of education were indicators for a delay. The studies propose that many delays are unjustified and not according to genuine contraindications. CONCLUSION: This review indicates that preterm infants are not vaccinated in a timely manner. Those involved in vaccinating preterm infants must be informed of the genuine contraindications to avoid unnecessary delays putting preterm infants at an increased risk of infection. RELEVANCE TO CLINICAL PRACTICE: Care providers should acknowledge the risk of a delay in preterm infants and actively promote vaccination in this population. Regular training should help to negate the occurrence of inappropriate delays, and careful discharge planning is needed to ensure that preterm infants are vaccinated on time.

Factors affecting the programme completion of pre-registration nursing students through a three year course: A retrospective cohort study.

Students who leave pre-registration nurse education having failed to complete remain a concern for higher education institutions. This study identifed factors influencing completion using a retrospective cohort analysis to map student characteristics at entry against Year 3 completion data. The study was set in a nursing faculty in a higher education institution in northern England. Data were collected between 2009 and 2014 with five cohorts of students participating (n = 807). Multinomial logistic regression was used to model the dependent variable Progression Outcome with categories of; completion and non-completion (academic and non-academic reasons). Predictors included cohort, programme, branch, gender, age on entry, ethnic group, disability status, domicile, change of home postcode, change of term-time postcode, entry qualifications, previous experience of caring, and dependents. Age on Entry and Domicile or alternatively Dependents and Domicile emerged as statistically significant (p < 0.05) in the multivariable analysis. Older students were less likely to be lost from the programme, as were students who lived locally at all times and those with dependents. There is currently little reliable, consistent information on nursing student attrition, progression and completion. This study contributes to the evidence base by identifying some of the factors that may contribute to successful programme completion.

Skin cleansing and emolliating for older people: A quasi-experimental pilot study.

AIMS: The aims of this study were to (i) assess the effect of low-cost hygiene and emollient regimens on the skin barrier function (SBF) of people aged >65 year with xerosis (dry skin) on their lower legs; (ii) to assess the utility of portable measures of skin barrier function in terms of stratum corneum hydration (SCH) and transepidermal water loss (TEWL) in community settings; and iii) to provide evidence for a randomised controlled trial on the treatment of adults in a resource-poor country with dry skin on their lower legs which causes and exacerbates the skin disease podoconiosis (non-filarial elephantiasis). BACKGROUND: Age increases the risk of impaired skin barrier function which can precipitate skin breakdown. Older skin is frequently characterised by troublesome xerosis and pruritus (itching). Hygiene and emollient practices are central to maintaining skin integrity but are currently under-researched. METHOD: A quasi-experimental pilot study of five combinations of cleansing and emollient interventions was applied to the xerotic lower legs of ten participants with no skin disease for five consecutive days. Stratum corneum hydration and transepidermal water loss were measured at baseline and day six. Products were chosen because of effectiveness, low cost and availability in a poor-resource country. RESULTS: The greatest difference in transepidermal water loss pre-intervention-postintervention was indicated by the regimen of soapy water, 2% glycerine soak and Vaseline™ (mean 1.14, SD 1.27). This regimen also indicated the greatest difference in stratum corneum hydration (mean 7.92, SD 3.93). The improvement in stratum corneum hydration was significantly greater than for the control (p = .011), soap (p = .050) or water soak (p = .011). CONCLUSION: A regimen of washing skin with soapy water, soaking in 2% glycerine for 30 min and applying Vaseline™ has a beneficial effect on the skin barrier function in older people. The study supports previous findings on the positive effects of glycerine on skin barrier function. IMPLICATIONS FOR PRACTICE AND RESEARCH: Skin barrier function in older people can be improved using a regimen of washing, soaking in 2% glycerine and applying Vaseline™ .

Psychological and educational interventions for atopic eczema in children.

BACKGROUND: Psychological and educational interventions have been used as an adjunct to conventional therapy for children with atopic eczema to enhance the effectiveness of topical therapy. This is an update of the original Cochrane review. OBJECTIVES: To assess the effect of psychological and educational interventions for atopic eczema in children. SEARCH METHODS: We updated our searches of the following databases to January 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 12), MEDLINE (from 1946), EMBASE (from 1974), OpenGrey, and PsycINFO (from 1806). We also searched six trials registers and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA: Randomised controlled trials of psychological or educational interventions, or both, used to assist children and their carers in managing atopic eczema. DATA COLLECTION AND ANALYSIS: Three authors independently applied eligibility criteria, assessed trial quality, and extracted data. A lack of comparable data prevented data synthesis, and we were unable to conduct meta-analysis because there were insufficient data. MAIN RESULTS: We included 10 RCTs, of which 5 were new to this update; all interventions were adjuncts to conventional therapy and were delivered in primary- and secondary-care settings. There were 2003 participants in the 9 educational interventions and 44 participants in the 1 psychological study. Some included studies had methodological weaknesses; for example, we judged four studies to have high risk of detection bias, attrition bias, or other bias. Our primary outcomes were participant-rated global assessment, reduction in disease severity (reported as objective SCORAD (SCORing Atopic Dermatitis)), and improvement in sleep and quality of life. No study reported participant-rated global assessment or improvement of sleep.The largest and most robust study (n = 992) demonstrated significant reduction in disease severity and improvement in quality of life, in both nurse- and dermatologist-led intervention groups. It provided six standardised, age-appropriate group education sessions. Statistically significant improvements in objective severity using the SCORAD clinical tool were recorded for all intervention groups when compared with controls. Improvements in objective severity (intervention minus no intervention) by age group were as follows: age 3 months to 7 years = 4.2, 95% confidence interval (CI) 1.7 to 6.8; age 8 to 12 years = 6.7, 95% CI 2.1 to 11.2; and age 13 to 18 years = 9.9, 95% CI 4.3 to 15.5. In three of five studies, which could not be combined because of their heterogeneity, the objective SCORAD measure was statistically significantly better in the intervention group compared with the usual care groups. However, in all of the above studies, the confidence interval limits do not exceed the minimum clinically important difference of 8.2 for objective SCORAD.The largest study measured quality of life using the German 'Quality of life in parents of children with atopic dermatitis' questionnaire, a validated tool with five subscales. Parents of children under seven years had significantly better improvements in the intervention group on all five subscales. Parents of children aged 8 to 12 years experienced significantly better improvements in the intervention group on 3 of the 5 subscales. AUTHORS' CONCLUSIONS: This update has incorporated five new RCTs using educational interventions as an adjunct to conventional treatment for children with atopic eczema. We did not identify any further studies using psychological interventions. The inclusion of new studies has not substantially altered the conclusions from the original review. The educational studies in both the original review and this update lack detail about intervention design and do not use a complex interventions framework. Few use an explicit theoretical base, and the components of each intervention are not sufficiently well described to allow replication. A relative lack of rigorously designed trials provides limited evidence of the effectiveness of educational and psychological interventions in helping to manage the condition of atopic eczema in children. However, there is some evidence from included paediatric studies using different educational intervention delivery models (multiprofessional eczema interventions and nurse-led clinics) that these may lead to improvements in disease severity and quality of life. Educational and psychological interventions require further development using a complex interventions framework. Comparative evaluation is needed to examine their impact on eczema severity, quality of life, psychological distress, and cost-effectiveness. There is also a need for comparison of educational interventions with stand-alone psychosocial self-help.  

Sexual health information seeking: a survey of adolescent practices.

AIMS AND OBJECTIVES: To identify sources of information and support preferred by young people to understand adolescent practices as adolescents develop a sexual health knowledge base. BACKGROUND: Statistics suggest that adolescents are not always making safe sexual health decisions. It is essential to develop an understanding of preferred sources of information and support to structure health and education services so that adolescents develop skills and knowledge to make safer choices. DESIGN: A cross-sectional survey design. METHODS: A wide-ranging questionnaire was developed using validated questions, drawn from similar adolescent lifestyle surveys and adapted with guidance from an advisory group; 2036 13-16-year-olds responded. Two questions, reporting information sources adolescents find useful and sources of approachable support, are considered here. RESULTS: Adolescents find informal sources more useful and experience higher levels of comfort accessing informal support especially from their best friends and mothers. Of formal provision, school-based sources are preferred; however, sexual health information seeking is gendered and changes across year groups. The range of sexual health information sources adolescents access increases with age, and how they access these information sources changes as sexual activity increases and the information becomes more relevant. CONCLUSIONS: The findings support the targeting of sexual health provision in relation to age and gender and suggest a youth-focused approach to formal provision, including outreach working and a collaborative relationship with adolescents and parents. RELEVANCE TO CLINICAL PRACTICE: The findings contribute to an understanding of sources of information and support preferred by adolescents. In particular, they need to reconsider how services external to the school may be developed so they are youth-focused and approachable. Nurses need to consider how best to work in partnership with adolescents and their families to disseminate accurate information and develop relevant services.

A randomised controlled trial comparing graded exercise treatment and usual physiotherapy for patients with non-specific neck pain (the GET UP neck pain trial).

Evidence supports exercise-based interventions for the management of neck pain, however there is little evidence of its superiority over usual physiotherapy. This study investigated the effectiveness of a group neck and upper limb exercise programme (GET) compared with usual physiotherapy (UP) for patients with non-specific neck pain. A total of 151 adult patients were randomised to either GET or UP. The primary measure was the Northwick Park Neck pain Questionnaire (NPQ) score at six weeks, six months and 12 months. Mixed modelling identified no difference in neck pain and function between patients receiving GET and those receiving UP at any follow-up time point. Both interventions resulted in modest significant and clinically important improvements on the NPQ score with a change score of around 9% between baseline and 12 months. Both GET and UP are appropriate clinical interventions for patients with non-specific neck pain, however preferences for treatment and targeted strategies to address barriers to adherence may need to be considered in order to maximise the effectiveness of these approaches.

Staying the course: factors influencing pre-registration nursing student progression into year 2: a retrospective cohort study.

AIMS/BACKGROUND: The retention of student nurses continues to concern the education sector internationally. Evidence shows that individual factors are correlated with a high risk of attrition, including age, disability, entry qualifications, financial issues, and placement experience. This paper is a report of a study that aimed to examine factors connected to progression and attrition by mapping student characteristics against Year 1 progression data. METHOD: The study used a retrospective cohort design. Students within five cohorts in a single University in the north of England were invited to be included (n=807). Quantitative data were collected from the University's information system (October 2009-January 2010). Of the total potential participants, 695 were included (13.8% excluded). Multinomial logistic regression was used to ascertain factors that predicted progression. RESULTS: As age on entry increased, the likelihood of non-progression from year one became less: i.e. older students appeared to be more likely to progress than their younger counterparts (p<0.001, likelihood ratio chi-square test). Students who lived away from the local area outside term-time were significantly less likely to progress than those whose term-time and holiday domicile were the same (p=0.007, likelihood ratio chi-square test). Students with dependents or previous care experience seemed more likely to progress than those without, although this was not statistically significant in a multivariable regression model. CONCLUSION: With the changing demographic profile of students, the new 'all-graduate' programmes need to consider student characteristics that are correlated with likelihood of progression and not just focus on those that precipitate exit.

The influence of 'cognitive busyness' on causal attributions of challenging behaviour in dementia: a preliminary experimental study.

This study investigated the influence of 'cognitive busyness' (competing cognitive demands) on residential care staff attributions of challenging behaviour (CB) related to dementia. Following the model of attribution formation proposed by Gilbert, Pelham, and Krull (1988), it was hypothesised that care staff experiencing competing cognitive demands at the time of observing CBs linked with dementia would be more likely to make internal and controllable attributions regarding the causes of such behaviour. This study employed a cross-over experimental design. Thirty formal dementia care-workers viewed two video clips of simulated CB, one under conditions of cognitive 'busyness' and another under control conditions of no extra cognitive demands. These conditions occurred a week apart and were counterbalanced, i.e. one group of participants undertook the control condition first and then the experimental condition whilst another undertook the reverse. Self-report measures of attributions were administered after the viewing of each video clip. Competing cognitive demands significantly influenced staff attributions regarding CB, in relation to internality and controllability, and type of CB emerged as a potential moderating factor. No link was found between cognitive busyness and other attributional dimensions (stability and globality). Concurrent cognitive demands seem capable of impairing the ability to use situational information to form some causal attributions regarding CB in dementia but this might depend on the type of CB being witnessed. The results are discussed in relation to key methodological and conceptual issues.

An investigation to determine the association between neck pain and upper limb disability for patients with non-specific neck pain: a secondary analysis.

This study investigated the relationship between neck pain and upper limb disability in patients with non-specific neck pain (n = 151) recruited from physiotherapy departments in the United Kingdom. Baseline neck pain/disability was measured using the Northwick Park Neck Pain Questionnaire (NPQ). Baseline upper limb disability was measured using the Disabilities of Arm, Shoulder, Hand questionnaire (DASH). A range of baseline psychosocial variables were measured as potential confounding variables. Pairwise analysis revealed a positive correlation between NPQ score and DASH score (Pearsons' r = 0.799, p < 0.001). After adjusting for potential confounding variables, stepwise linear regression indicated that increasing upper limb disability was predicted by two baseline variables: higher NPQ scores (B = 0.743) and lower pain self efficacy (PSE) scores (B = -0.489) {R(2) = 0.713; n = 100, p < 0.001}. This study provides preliminary evidence that patients with severe neck pain/disability also report severe upper limb disability. The relationship between neck pain/disability and upper limb disability was mediated by PSE. Clinically, the presence of severe neck pain or low PSE should direct clinicians towards an assessment of upper limb function. In these cases upper limb disability may need to be addressed as part of the neck management process.

Risk factors for the onset of non-specific neck pain: a systematic review.

OBJECTIVE: Neck pain is a common musculoskeletal disorder, but little is known about which individuals develop neck pain. This systematic review investigated factors that constitute a risk for the onset of non-specific neck pain. DESIGN AND SETTING: A range of electronic databases and reference sections of relevant articles were searched to identify appropriate articles. Studies investigating risk factors for the onset of non-specific neck pain in asymptomatic populations were included. All studies were prospective with at least 1 year follow-up. MAIN RESULTS: 14 independent cohort studies met the inclusion criteria for the review. Thirteen studies were assessed as high quality. Female gender, older age, high job demands, low social/work support, being an ex-smoker, a history of low back disorders and a history of neck disorders were linked to the development of non-specific neck pain. CONCLUSIONS: Various clinical and sociodemographic risk factors were identified that have implications for occupational health and health policy. However, there was a lack of good-quality research investigating the predictive nature of many other variables.

Weight-adjusted dalteparin for prevention of vascular thromboembolism in advanced pancreatic cancer patients decreases serum tissue factor and serum-mediated induction of cancer cell invasion.

The aim of the present study was to assess the role of tissue factor and serum-induced cell invasion in patients with advanced pancreatic cancer (APC). A cohort of 39 patients with APC, without thrombosis, receiving chemotherapy, were entered in a randomized controlled trial (ISRCTN = 76464767) of thromboprevention with weight-adjusted dalteparin (WAD). A total of 19 patients received WAD, the remaining 20 acting as a control group. Serum from baseline and week 8 was analysed for circulating-tissue factor antigen using ELISA. Circulating-tissue factor antigen rose from 324 pg/ml, [interquartile range (IQR) 282-347 pg/ml] to 356 pg/ml, (IQR 319-431 pg/ml) in controls (C), and decreased in the dalteparin-treated group (D) from 336 pg/ml (IQR 281-346 pg/ml) to 303 pg/ml (IQR 274-339 pg/ml). The difference in median percentage change between D and C was statistically significant [-4.0 (D) vs. 4.7 (C); P = 0.005, n = 39]. Serum-induced cellular invasion of MIA-Paca-2 cells in response to patient serum was studied using a Boyden chamber assay in 30 patients (14 WAD and 16 C). The median percentage change between C and D was significant [+54.9 (C) vs. -21.9 (D) P = 0.025, n = 30]. There was a weak correlation between BB-tissue factor reduction and cellular invasion reduction (Spearman) [0.384 (P = 0.037, n = 30)]. APC patients treated with WAD have lower tissue factor antigen levels and attenuated induction of cellular invasion in their blood. These assays may provide useful markers to guide appropriate dalteparin (and other low-molecular weight heparin) dosing schedules to optimize anticancer effects of dalteparin in APC.

Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review.

Poor adherence to treatment can have negative effects on outcomes and healthcare cost. However, little is known about the barriers to treatment adherence within physiotherapy. The aim of this systematic review was to identify barriers to treatment adherence in patients typically managed in musculoskeletal physiotherapy outpatient settings and suggest strategies for reducing their impact. The review included twenty high quality studies investigating barriers to treatment adherence in musculoskeletal populations. There was strong evidence that poor treatment adherence was associated with low levels of physical activity at baseline or in previous weeks, low in-treatment adherence with exercise, low self-efficacy, depression, anxiety, helplessness, poor social support/activity, greater perceived number of barriers to exercise and increased pain levels during exercise. Strategies to overcome these barriers and improve adherence are considered. We found limited evidence for many factors and further high quality research is required to investigate the predictive validity of these potential barriers. Much of the available research has focussed on patient factors and additional research is required to investigate the barriers introduced by health professionals or health organisations, since these factors are also likely to influence patient adherence with treatment.

Which women should be selected for vertebral fracture assessment? Comparing different methods of targeting VFA.

Vertebral fracture assessment (VFA) is a potential screening tool for vertebral fractures, but it is uncertain how to optimize the selection of women for VFA. We investigate the use of a probability score (VFscore) to select women for VFA screening and compare this to other means of targeting VFA. We identified 1,572 treatment-naive women over age 65 who had undergone routine VFA screening. Risk factors for fracture on VFA were identified using multivariate logistic regression, and a VFscore was created. Different thresholds of VFscore were examined and compared to using BMD as a means of targeting screening. After multivariate logistic regression, the risk factors significantly associated with the presence of a fracture on VFA were age, femoral neck BMD, prior clinical fracture, and height loss/kyphosis. The VFscore derived from these factors had a 65.5% sensitivity and a 65.5% specificity for determining vertebral fracture status. For equal resource requirements, the VFscore identified more women with fracture than using BMD category to target VFA. Compared to routinely screening all women, VFscore enabled a 30% reduction in the number of women undergoing VFA while still identifying >90% of women with a vertebral fracture. Overall, a large proportion of the population is required to undergo VFA in order to ensure that the majority of women with a vertebral fracture are selected for screening. The VFscore increased the efficiency of VFA screening to a modest degree compared to screening routinely or according to BMD category.

A longitudinal study of stress and psychological distress in nurses and nursing students.

AIM: The aim of this study was to investigate how differences in life events and stress contribute to psychological distress in nurses and nursing students. BACKGROUND: Stress is an issue for nursing students and qualified nurses leading to psychological distress and attrition. DESIGN: A longitudinal study using four time waves was conducted between 1994-1997. METHODS: Measures were taken of stress, life events and psychological distress in addition to a range of demographic data. Data were analysed using descriptive statistics, linear modelling and mixed-effects modelling. The study was set in Scotland, UK and used newly qualified nurses and nursing students from four university departments of nursing over four years. The study was initiated with 359 participants (147 nurses and 212 nursing students) and complete data were obtained for 192 participants. RESULTS: Stress levels, psychological distress and life events are all associated within time and across time. At baseline, life events and stress contributed significantly to psychological distress. The pattern of psychological distress differed between the nursing students and the newly qualified nurses with a high level in the nurses after qualifying and starting their career. CONCLUSION: Stress, individual traits, adverse life events and psychological distress are all interrelated. Future lines of enquiry should focus on the transition between being a nursing student and becoming a nurse. RELEVANCE TO CLINICAL PRACTICE: Stress and psychological distress may have negative outcomes for the retention of nursing students in programmes of study and newly qualified nurses in the nursing workforce.

Predictor Variables for a Positive Long-Term Functional Outcome in Patients with Acute and Chronic Neck and Back Pain Treated with a McKenzie Approach: A Secondary Analysis.

A cognitive behavioral approach was previously compared to a biomechanical approach (the McKenzie method) for the treatment of patients with back and neck pain in a randomized trial. Few differences between the treatment interventions were found. The aim of this secondary analysis was to determine if any clinical characteristics distinguished those patients who responded best to the McKenzie approach. Treatment success was defined as 50% reduction in original functional disability scores (Roland-Morris Disability Questionnaire or Northwick Park Neck Pain Questionnaire); failure to achieve this was defined as treatment failure. A liberal definition of success was 50% improvement retained at either 6 or 12 months, whereas a strict definition of success was 50% improvement at both 6 and 12 months. Ten variables were screened by univariate regression analysis to see if they predicted success. Any significant variables (P < 0.1) underwent multiple regression analysis. Only 21 and 16 patients out of 102 were deemed treatment successes according to the liberal and strict definitions, respectively. With the liberal definition, only centralization (P = 0.065), spine region (back rather than neck pain) (P = 0.089), and duration of pain (P = 0.001) emerged as predictors from the univariate regression analysis. With the strict definition, only the latter two variables emerged: spine region (P = 0.026) and duration of pain (P <0.01). All these variables were retained in the multiple regression analysis. In this study, duration of pain was the strongest predictor of success, although back pain and centralization had some predictive ability.